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7
Clinical Manifestation of Disease
Prepared by:malek ahmad
University of Malaya
Tremor
•Abolished on movement•Eg: parkinsonism
Resting tremor•Increase amplitude as reach target (dysmetria)•Eg: cerebellar damage (MS, stroke)Intentional
tremor
•Amplitude remains the same throughout movement (no dysmetria)
•Eg: essential tremor
Action tremor
•Present on maintained posture•Eg: benign essential tremor (AD, improve with alcohol), anxiety,
thyrotoxicosis, B-agonistPostural tremor
•Postural tremor developing after a delay of ~10sec•Eg: parkinsonRe-emergent
tremor
Rhythmic, oscillatory movement of body part (hands and legs)
Approach of patient with tremor
Sit up with arm supported by pillow (accentuated by count 100 backward)
Stretch out the arms with fingers seperated
Finger-nose test
Rest tremor
Postural tremor
Intentional trempr
Action tremorIn exam always think of
Parkinson’s disease
Cerebellar signs
•Slurred/ataxic/staccatoSpeech
•Nystagmus Eye movement
•Reduce Tone and power
•Finger-nose test/dysdiadochokinesia
Coordination
•Failed Romberg’s testyGaits
•Intentional tremorTremor
DANISH
Assessment of coordination
• Finger-nose test• Dysdiadochokinesia• Pronator driftUL• Heel-shin test
LL
Dupuytren contractureNodular thickening of CT over 4th and 5th finger
Local hypoxia, ischemia, increase XO xtvt, reduce O2, free radical, fibroblast proliferation, type III collagen, fibrosis
Alcohol Smoking
Heavy manual labour
Trauma
Palmar erythema
Liver dysfunction –
portal HPTPregnan
cy
Polycythemia
Thyrotoxicosis
Dermatoses- exzema/psori
asis RA
Finger clubbing CVS• Cyanotic heart disease• IE• Infected graft• Aneurysm• Atrial myxoma
RESPI• Bronchiectasis• CF• Cancer • Empyema• Fibrosing alveolitis• TB• Mesothelioma
GIT• GI lymphoma• IBD• Malabsorption;coeliac• Cirrhosis
Unilateral • UL artery aneurysm• Bronchial AV
malformation
Grade •Softening of nail bedGrade I•Obliteration of the angle of the nail bedGrade II
•Overlying skin to become tense, shiny and wet and increasing the curvature of the nail, resulting in parrot beak or drumstick appearanceGrade III•Swelling of the fingers in all dimensions associated pain and swelling of the wrist and radiographic evidence of subperiosteal new bone formationGrade IV
Occur due to interruption of
Face sympathetic supply
• At brainstem: demyelination, vascular disease• At cord: syringomyelia• At thoracic outlet: pancoast’s tumor
Sympathetic’s trip on internal carotid artery
• Into the skull: carotid aneurysm• Thence the orbit
Horner’s syndrome
•Ptosis P•Anhydrosis A •Myosis M•EnopthalmosE•Loss of ciliaspinal reflexLa
Pancoast’s syndrome
Invade sympathetic plexus
• Ipsilateral horner’s syndrome
Brachial plexus
• Arm pain
Recurrent laryngeal nerve
• Hoarse voice, bovine cough, due to vocal cord palsy
RA: 0-8 mmHg
LA: 1-10 mmHg
RV: 15-30 / 0-8 mmHg
LV: 100-140 / 5-12 mmHg
PA: 15-30 / 3-12 mmHg
AO: 100-140 / 60-80 mmHg
O2 saturation:LH (95%)RH (75%)